Medical device including setup option reporting

ABSTRACT

A medical device for use with a patient is described. The medical device includes a component for administering a treatment to the patient or receiving data of the patient. The component is configured to operate according to an internal setting. The medical device also includes a user interface through which a user can modify the internal setting, as well as a settings signature generator for generating a settings signature that represents a present state of the internal setting. A gateway is also provided for communicating a version of the settings signature out of the medical device.

CROSS REFERENCE TO RELATED PATENT APPLICATIONS

This patent application claims benefit from U.S. Provisional PatentApplication Ser. No. 61/418,369, titled DEVICE SETUP CHANGE DETECTION,filed on Nov. 30, 2010, and U.S. patent application Ser. No. 13/308,329,titled MEDICAL DEVICE INCLUDING SETUP OPTION REPORTING, filed on Nov.30, 2011, the disclosure of which is hereby incorporated by referencefor all purposes.

FIELD

This invention generally relates to medical devices and relatedcommunications systems.

BACKGROUND

In humans, the heart beats to sustain life. In normal operation, itpumps blood through the various parts of the body. More particularly,the various chamber of the heart contract and expand in a periodic andcoordinated fashion, which causes the blood to be pumped regularly. Morespecifically, the right atrium sends deoxygenated blood into the rightventricle. The right ventricle pumps the blood to the lungs, where itbecomes oxygenated, and from where it returns to the left atrium. Theleft atrium pumps the oxygenated blood to the left ventricle. The leftventricle, then, expels the blood, forcing it to circulate to thevarious parts of the body.

The heart chambers pump because of the heart's electrical controlsystem. More particularly, the sinoatrial (SA) node generates anelectrical impulse, which generates further electrical signals. Thesefurther signals cause the above-described contractions of the variouschambers in the heart, in the correct sequence. The electrical patterncreated by the sinoatrial (SA) node is called a sinus rhythm.

Sometimes, however, the electrical control system of the heartmalfunctions, which can cause the heart to beat irregularly, or not atall. The cardiac rhythm is then generally called an arrhythmia.Arrhythmias may be caused by electrical activity from locations in theheart other than the SA node. Some types of arrhythmia may result ininadequate blood flow, thus reducing the amount of blood pumped to thevarious parts of the body. Some arrhythmias may even result in a SuddenCardiac Arrest (SCA). In a SCA, the heart fails to pump bloodeffectively, and, if not treated, death can occur. In fact, it isestimated that SCA results in more than 250,000 deaths per year in theUnited States alone. Further, a SCA may result from a condition otherthan an arrhythmia.

One type of arrhythmia associated with SCA is known as VentricularFibrillation (VF). VF is a type of malfunction where the ventricles makerapid, uncoordinated movements, instead of the normal contractions. Whenthat happens, the heart does not pump enough blood to deliver enoughoxygen to the vital organs. The person's condition will deterioraterapidly and, if not reversed in time, they will die soon, e.g. withinten minutes.

Ventricular Fibrillation can often be reversed using a life-savingdevice called a defibrillator. A defibrillator, if applied properly, canadminister an electrical shock to the heart. The shock may terminate theVF, thus giving the heart the opportunity to resume pumping blood. If VFis not terminated, the shock may be repeated, often at escalatingenergies.

A challenge with defibrillation is that the electrical shock must beadministered very soon after the onset of VF. There is not much time:the survival rate of persons suffering from VF decreases by about 10%for each minute the administration of a defibrillation shock is delayed.After about 10 minutes the rate of survival for SCA victims averagesless than 2%.

The challenge of defibrillating early after the onset of VF is being metin a number of ways. First, for some people who are considered to be ata higher risk of VF or other heart arrythmias, an ImplantableCardioverter Defibrillator (ICD) can be implanted surgically. An ICD canmonitor the person's heart, and administer an electrical shock asneeded. As such, an ICD reduces the need to have the higher-risk personbe monitored constantly by medical personnel.

Regardless, VF can occur unpredictably, even to a person who is notconsidered at risk. As such, VF can be experienced by many people wholack the benefit of ICD therapy. When VF occurs to a person who does nothave an ICD, they collapse, because blood flow has stopped. They shouldreceive therapy quickly.

For a VF victim without an ICD, a different type of defibrillator can beused, which is called an external defibrillator. External defibrillatorshave been made portable, so they can be brought to a potential VF victimquickly enough to revive them.

During VF, the person's condition deteriorates, because the blood is notflowing to the brain, heart, lungs, and other organs. Blood flow must berestored, if resuscitation attempts are to be successful.

Cardiopulmonary Resuscitation (CPR) is one method of forcing blood flowin a person experiencing cardiac arrest. In addition, CPR is the primaryrecommended treatment for some patients with some kinds of non-VFcardiac arrest, such as asystole and pulseless electrical activity(PEA). CPR is a combination of techniques that include chestcompressions to force blood circulation, and rescue breathing to forcerespiration.

Properly administered CPR provides oxygenated blood to critical organsof a person in cardiac arrest, thereby minimizing the deterioration thatwould otherwise occur. As such, CPR can be beneficial for personsexperiencing VF, because it slows the deterioration that would otherwiseoccur while a defibrillator is being retrieved. Indeed, for patientswith an extended down-time, survival rates are higher if CPR isadministered prior to defibrillation.

Advanced medical devices can actually coach a rescuer who performs CPR.For example, a medical device can issue instructions, and even prompts,for the rescuer to perform CPR more effectively.

Medical devices typically have several option settings that govern howparticular components or functions within the medical device operate.For example, an audible alarm may be selectively enabled and a volumecontrolled through a user interface. Giving a user of the medical devicecontrol of how the medical device functions allows the user to tailoroperation of the device for particular situations or operatingconditions. A medical director, for example within an emergency medicalservice, may have the responsibility for ensuring medical devices areproperly configured and operated. Giving the user an ability to modifythe configuration of the medical device through the setup options of thedevice, while convenient for the user, may allow the user to change aconfiguration of the device contrary to the direction of the medicaldirector or other party. Embodiments of the invention address this andother limitations in the prior art.

BRIEF SUMMARY

The present description gives instances of devices, systems, softwareand methods, the use of which may help overcome problems and limitationsof the prior art.

In one embodiment, a medical device for use with a patient includes acomponent for either administering a treatment to the patient orreceiving data of the patient. The component is configured to operateaccording to an internal setting. The medical device also includes auser interface through which a user can modify the internal setting anda settings signature generator for generating a settings signature thatrepresents a present state of the internal setting. The medical devicefurther includes a gateway for communicating a version of the settingssignature out of the medical device.

Another embodiment is directed to a method for use with a medicaldevice, in which the medical device has a component for administering atreatment to a patient or for receiving data of the patient. The methodincludes receiving a version of the settings signature generated by themedical device over a communication network and outputting a warning ifit is determined from the settings signature that the internal settingdeviates from an expected state of the internal setting.

An advantage over the prior art is that a medical director or otherparty may be informed when the user changes a setting on the medicaldevice.

These and other features and advantages of this description will becomemore readily apparent from the following Detailed Description, whichproceeds with reference to the drawings, in which:

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a functional block diagram of a medical device that generatesa setup signature according to embodiments.

FIG. 2 is a diagram showing components of an external defibrillator,which may be an example medical device of FIG. 1, according toembodiments.

FIG. 3 is a system diagram of a communication system that incorporatesthe medical device, such as the medical device of FIG. 1, according toembodiments of the invention.

FIG. 4 is a chart illustrating example component functions and examplesettings that may be stored in the medical device of FIG. 1.

FIG. 5 is a flowchart illustrating example methods for detecting setupoption change in a medical device according to embodiments.

DETAILED DESCRIPTION

As has been mentioned, the present description is about medical devicesand devices, software and methods for reporting changes in setup optionsof the medical device. Embodiments are now described in more detail.

FIG. 1 is a functional block diagram of a medical device that generatesa setup signature according to embodiments. A medical device 102 is foruse with a patient, not illustrated. In some embodiments the patient isexperiencing cardiac arrest and the medical device is a defibrillator.The medical device 102 includes a component 104 for administering atreatment to the patient or for receiving data of the patient. Forexample, the component 104 may be an energy storage device for providingan electric charge to the patient. Or, in another example, the component104 may be a non-invasive blood pressure monitor. The component 104 isconfigured to operate according to an internal setting or settings, asdescribed in detail below. The internal setting is stored, along withinternal settings for other, optional, components, such as a component106, in user settings 108. The user settings 108 may be, for example, amemory that is internal to the medical device 102. The medical devicealso 102 includes a user interface 116, such as a touchscreen, throughwhich a user can modify the user settings 108.

A settings signature generator 110 generates a settings signature 112that represents a present state of internal settings in the usersettings 108. For example, the settings signature generator 110 mayperform a computer function on data in the user settings 108 to computethe settings signature 112. In some embodiments, the settings signature112 is a cyclic redundancy check of a memory block that stores the usersettings 108. In other embodiments the settings signature 112 is derivedfrom a hash function of at least a portion of a memory block storing theuser settings 108. The hash function may be a message digest function,such as MD5, for example. In other embodiments, the settings signature112 is merely a coded version of the user settings 108. Depending on thecode, particular settings of the medical device 102 may be able to bedecoded and discerned merely by analyzing the coded version of thesettings signature 112. For example, in such an embodiment, a receivercould determine an energy setting of the particular medical device byanalyzing the version of the settings signature 112 in which the energysetting is stored. Typically, having a settings signature 112 that canbe decoded will be larger, take more storage, and require morecommunication bandwidth than a settings signature that merely identifiesa current set of user settings 108.

The medical device 102 may generate the settings signature 112 on aregular schedule. For example, the settings signature generator 110 maybe structured to generate the settings signature 112 substantiallyperiodically. In other embodiments, the settings signature generator 110may be structured to generate the settings signature 112 in response toan external query, such as a query through a remote setup interface 118,described below.

The medical device 102 includes a gateway 114 for communicating aversion of the settings signature out of the medical device. The datasent from the device may be a predefined data structure, such as a datapackage 130, which includes a version of the settings signature 134. Theversion of the settings signature 134 is derived from the settingssignature 112, and in some embodiments may be identical to the settingssignature 112. In other embodiments, the version of the settingssignature 134 is a packetized version of the settings signature 112especially where the settings signature 112 is too long to fit in asingle packet.

As illustrated in FIG. 1, the data package 130 may optionally include aversion of patient data 132, so that the patient data is communicatedout of the medical device 102 in conjunction with the version of thesettings signature 134. As described above, one or more of thecomponents 104, 106 of the medical device 102 may gather data from apatient. The data package 130 may optionally include some or all of thepatient data gathered in a version of the patient data 132. The datapackage 130 may also optionally include a device identification 136,which may be transmitted from the gateway 114 of the medical device 102.This is described in more detail below, with reference to FIG. 3. Insome embodiments the predefined data structure, such as the data package130, includes a section for device data, within which the version of thesettings signature 134 and the optional device identification 136 isstored.

The medical device may send the version of the settings signature 134 ona regular schedule. For example, in some embodiments, the gateway 114may be structured to communicate the version of the settings signature134 substantially periodically. In other embodiments, the gateway 114may be structured to communicate the version of the settings signature134 in response to an event. The event may be an external query, forexample, received through the remote setup interface 118 or other port.The external query to cause the version of the settings signature 134 tobe sent from the medical device 102 may be performed before or duringthe time that the medical device is used on the patient. In otherembodiments, the device 102 is programmed so that the event is thetaking of an ECG of a patient.

FIG. 2 is a diagram showing components of an external defibrillator 200made according to embodiments. The external defibrillator 200 may be anembodiment of the medical device 102 described with reference to FIG. 1.

External defibrillator 200 is intended for use by a user 280, who wouldbe the rescuer. Defibrillator 200 typically includes a defibrillationport 210, such as a socket in housing 201. Defibrillation port 210includes nodes 214, 218. Defibrillation electrodes 204, 208, can beplugged in defibrillation port 210, so as to make electrical contactwith nodes 214, 218, respectively. It is also possible that electrodescan be connected continuously to defibrillation port 210, etc. Eitherway, defibrillation port 210 can be used for guiding via electrodes toperson an electrical charge that has been stored in defibrillator 200.

If defibrillator 200 is actually a defibrillator-monitor, then it willtypically also have an ECG port 219 in housing 201, for plugging in ECGleads 209. ECG leads 209 can help sense an ECG signal, e.g. a 12-leadsignal, or from a different number of leads. Moreover, adefibrillator-monitor could have additional ports (not shown), and another component 225 for the above described additional features, such aspatient signals. The other component 225 may be embodiments ofcomponents 104, 106 of FIG. 1.

Defibrillator 200 also includes a measurement circuit 220. Measurementcircuit 220 receives physiological signals from ECG port 219, and alsofrom other ports, if provided. These physiological signals are sensed,and information about them is rendered by circuit 220 as data, or othersignals, etc.

If defibrillator 200 is actually an AED, it may lack ECG port 219.Measurement circuit 220 can obtain physiological signals through nodes214, 218 instead, when defibrillation electrodes 204, 208 are attachedto a person. In these cases, a person's ECG signal can be sensed as avoltage difference between electrodes 204, 208. Plus, impedance betweenelectrodes 204, 208 can be sensed for detecting, among other things,whether these electrodes 204, 208 have been inadvertently disconnectedfrom the person.

Defibrillator 200 also includes a processor 230. Processor 230 may beimplemented in any number of ways. Such ways include, by way of exampleand not of limitation, digital and/or analog processors such asmicroprocessors and digital-signal processors (DSPs); controllers suchas microcontrollers; software running in a machine; programmablecircuits such as Field Programmable Gate Arrays (FPGAs),Field-Programmable Analog Arrays (FPAAs), Programmable Logic Devices(PLDs), Application Specific Integrated Circuits (ASICs), anycombination of one or more of these, and so on.

Processor 230 can be considered to have a number of modules. One suchmodule can be a detection module 232, which senses outputs ofmeasurement circuit 220. Detection module 232 can include a VF detector.Thus, the person's sensed ECG can be used to determine whether theperson is experiencing VF.

Another such module in processor 230 can be an advice module 234, whicharrives at advice based on outputs of detection module 232. Advicemodule 234 can include a Shock Advisory Algorithm, implement decisionrules, and so on. The advice can be to shock, to not shock, toadminister other forms of therapy, and so on. If the advice is to shock,some external defibrillator embodiments merely report that to the user,and prompt them to do it. Other embodiments further execute the advice,by administering the shock. If the advice is to administer CPR,defibrillator 200 may further issue prompts for it, and so on. thesemodules 232, 234 may be embodiments of components 104, 106 of FIG. 1.

Processor 230 can include additional modules, such as module 236, forother functions, such as the settings signature generator 110 of FIG. 1.In addition, if other component 225 is indeed provided, it may beoperated in part by processor 230, etc.

Defibrillator 200 optionally further includes a memory 238, which canwork together with processor 230. Memory 238 may be implemented in anynumber of ways. Such ways include, by way of example and not oflimitation, nonvolatile memories (NVM), read-only memories (ROM), randomaccess memories (RAM), any combination of these, and so on. Memory 238,if provided, can include programs for processor 230, and so on. Theprograms can be operational for the inherent needs of processor 230, andcan also include protocols and ways that decisions can be made by advicemodule 234. In addition, memory 238 can store prompts for user 280, etc.Moreover, memory 228 can store patient data. Memory 228 may also be alocation in which the user settings 108 of FIG. 1 are stored.Additionally, memory 228 may store the settings signature 112.

Defibrillator 200 may also include a power source 240. To enableportability of defibrillator 200, power source 240 typically includes abattery. Such a battery is typically implemented as a battery pack,which can be rechargeable or not. Sometimes, a combination is used, ofrechargeable and non-rechargeable battery packs. Other embodiments ofpower source 240 can include AC power override, for where AC power willbe available, and so on. In some embodiments, power source 240 iscontrolled by processor 230.

Defibrillator 200 additionally includes an energy storage module 250.Module 250 is where some electrical energy is stored, when preparing itfor sudden discharge to administer a shock. Module 250 can be chargedfrom power source 240 to the right amount of energy, as controlled byprocessor 230. In typical implementations, module 250 includes one ormore capacitors 252, and so on.

Defibrillator 200 moreover includes a discharge circuit 255. Circuit 255can be controlled to permit the energy stored in module 250 to bedischarged to nodes 214, 218, and thus also to defibrillation electrodes204, 208. Circuit 255 can include one or more switches 257. Those can bemade in a number of ways, such as by an H-bridge, and so on.

Defibrillator 200 further includes a user interface 270 for user 280.User interface 270 can be made in any number of ways. For example,interface 270 may include a screen, to display what is detected andmeasured, provide visual feedback to the rescuer for their resuscitationattempts, and so on. Interface 270 may also include a speaker, to issuevoice prompts, etc. Interface 270 may additionally include variouscontrols, such as pushbuttons, keyboards, and so on. In addition,discharge circuit 255 can be controlled by processor 230, or directly byuser 280 via user interface 270, and so on.

Defibrillator 200 can optionally include other components. For example,a communication module 290 may be provided for communicating with othermachines. Such communication can be performed wirelessly, or via wire,or by infrared communication, and so on. This way, data can becommunicated, such as patient data, incident information, therapyattempted, CPR performance, and so on.

Any of the components of the external defibrillator 200, such as thosedescribed above, may be embodiments of the components 104, 106 of FIG.1, that operate according to user settings 108. In operation, thedefibrillator 200 may generate a settings signature 112 of the usersettings of the defibrillator, as described above with reference toFIG. 1. A version of the settings signature 134, may be communicated outof the defibrillator 200 through a gateway 286, in the manner describedabove with reference to FIG. 1.

FIG. 3 is a system diagram of a communication system that incorporatesthe medical device 102 of FIG. 1 or the defibrillator 200 of FIG. 2. Anexample process for setting up and monitoring a medical device isdescribed below. A system 300 includes a medical device 302, which maybe the same or similar to the medical device 102 of FIG. 1, or theexternal defibrillator 200 of FIG. 2, for instance. A setup facility 310is coupled to the medical device 302, and passes data to and receivesdata from the medical device. In some embodiments the data may betransferred through the remote setup interface 118 illustrated in FIG.1, although other ports could also be used. In some embodiments thesetup facility 310 is a standalone process, such as a program running ona computer (not illustrated) used to set up the medical device 302. Inother embodiments the setup facility 310 may be resident on or a part ofthe medical device 302 itself.

The setup facility 310 is coupled through a communication network 306,such as the internet or other appropriate network, to a remoteconfiguration and device monitoring system 320. The remote configurationsystem 320 includes an output 322 and a setup input 321 for use by anindividual, such as a medical device supervisor 329.

In setup operation, an individual, such as the medical device supervisor329 provides setup specifications for the medical device 302, such as aninitial set of user settings 108 (FIG. 1) to be stored in the medicaldevice 302. The remote configuration system 320 sends setup data 332through the communication network 306 to the setup facility 310. In FIG.3 this is illustrated as setup data 332 leaving the remote configurationsystem 320, and setup data 334 being received by the setup facility 310.The setup facility 310 receives the setup data 334, then sends setupcodes and data 336 used to configure the medical device 302 to themedical device. The medical device 302, then configures itself based onthe received setup codes and data 336. For example, this may includestoring an initial state of settings in the user settings, such as usersettings 108 of FIG. 1. Thus in some embodiments, a medical deviceincludes a remote setup interface 118 through which data can bereceived, and in which the medical device is structured to set theinternal setting based on the data received through the remote setupinterface.

After the medical device 302 is configured, the medical device generatesa settings signature of the user settings, such as the settingssignature 112 of FIG. 1. The signature, and perhaps other data such asan acknowledgement that the medical device 302 has been set up is sentto the setup facility 310. This is illustrated as 342. Then the setupfacility 310 passes configuration data after setup 344 to thecommunication network 306, and further, illustrated as 346, to theremote configuration system 320. After the remote configuration system320 receives configuration data after setup 346 from the medical device302, the configuration system 320 stores a signature of the originalsetup as stored settings signature 325.

In monitoring operation, in general, the system 300 compares a settingssignature sent from the medical device 302, such as through the gateway114 (FIG. 1) or gateway 286 (FIG. 2) to the stored settings signature325 stored just after setup. If the signatures match, then the medicaldevice 302 is operating with the original user settings 108. If insteadthey don't match, that means that a user has adjusted the user settingsof the medical device. A warning may then be generated and sent from theoutput 322. If multiple medical devices 302 are coupled to the system300, the device identification 136 from a particular device may be usedto ensure the correct latest settings signature 323 is being compared tothe stored settings signature 325. In other embodiments, other deviceidentification techniques may be employed.

The medical device 302 sends a version of the settings signature 352,which may be in a data packet similar to the data package 130 of FIG. 1.The version of the settings signature 352 is sent to the communicationnetwork 306, which then optionally passes the version of the settingssignature 356 to an optional data parser 360. If present, the dataparser 360 may split a version of patient data 354, which was sent as350 from the medical device 302, from the version of the settingssignature 356. Then patient data 372 may optionally be sent to a patientdata reviewer 374, such as a doctor in a hospital.

The settings signature 364 is stored in the remote configuration anddevice monitoring system 320 as a latest settings signature 323. Then,the remote configuration and device monitoring system 330 periodicallycompares the latest settings signature 323 to the stored settingssignature 325. If they do not match, a warning is generated and sentthrough the output 322.

With reference to FIGS. 2 and 3, embodiments of the invention include asystem 300 for use with a medical device 302 having a component 250 foradministering a treatment to a patient or a component 220 for receivingdata of the patient. The system includes a processor 230 and a memory238 storing instructions which, when executed by the processor result insending a version of the settings signature 134, (FIG. 1) generated bythe medical device 302 over a communication network 306; and outputtinga warning if it is determined from the settings signature 323 that theinternal setting deviates from an expected state of the internal setting325. The system 300 determines the deviation by comparing the settingssignature 323 to a previously stored signature of the internal setting325, and generating the warning based on the comparison. In someembodiments, the remote configuration facility 320 stores instructionsin a second memory 327 which, when executed by a second processor 326result in specifying a particular setup configuration 332 of theinternal setting and transmitting data 346 identifying the particularsetup configuration to the medical device 302 across the communicationnetwork 306. As mentioned above, the version of the settings signature352 may be sent from the medical device 302 periodically, or may be sentbased on an event at the medical device 302. The system may also bestructured to transmitting a query to the medical device 302, and theevent that causes the medical device to send the version of the settingssignature 352 is the receipt of the query at the medical device 302. Insome embodiments, the warning from the output 322 of the remoteconfiguration and device monitoring system 320 is communicated to anagency outside the medical device 302.

FIG. 4 is a chart illustrating example functions and example settingsthat may be stored in the medical device of FIG. 1. For example, in someembodiments, the component 104 of the medical device 102 is adefibrillator and the internal setting in the user settings 108identifies a protocol of the defibrillator. The component 104 may bepermissively accessed and the internal setting in the user settings 108enables or disables the permissive access. In some embodiments thecomponent 104 is an energy delivery component and the internal settingin the user settings 108 sets an energy delivery level. If the component104 is a patient analyzer, the internal setting of the user settings 108determines whether the patient analyzer is set to analyze a patientwithout user action. For example, some patient analyzers include a modethat automatically analyze a patient, while other modes require a userto perform particular actions, such as by initiating analysis bypressing a button.

In some embodiments the component 104 is a CardioPulmonary Resuscitationtimer and the internal setting of the user settings 108 determines aduration. In some embodiments the component 104 is a pacer and theinternal setting of the user settings 108 describes a pacing rate. Insome embodiments the component 104 is a metronome and the internalsetting of the user settings 108 determines a metronome schedule. Insome embodiments the component 104 is a pacer and the internal settingof the user settings 108 identifies a pacer current. In some embodimentsthe component 104 is a data transmitter and the internal setting of theuser settings 108 describes a channel or address for transmission ofdata. For example, the medical device 102 may use a wireless version ofthe gateway 114, and the internal setting identifies how the wirelesscommunication with the medical device 102 is established. In otherembodiments the gateway 114 is connected to a communication network, andthe internal setting identifies a destination communication address.

In some embodiments the component 104 is a carbon dioxide monitor or ablood pressure monitor and the internal setting of the user settings 108describes the units of measure for the monitor. In some embodiments thecomponent 104 is an alarm and the internal setting of the user settings108 controls an alarm volume. In some embodiments the component 104 is apatient monitoring lead and the internal setting of the user settings108 determines whether patient data will be transferred without useraction.

In some embodiments the component 104 is an ECG display and the internalsetting of the user settings 108 includes an operation mode of thedisplay, or units of the ECG display. In some embodiments the component104 is a printer and the internal setting of the user settings 108includes a printer operation mode.

The functions of this description may be implemented by one or moredevices that include logic circuitry. The device performs functionsand/or methods as are described in this document. The logic circuitrymay include a processor that may be programmable for a general purpose,or dedicated, such as microcontroller, a microprocessor, a DigitalSignal Processor (DSP), etc. For example, the device may be a digitalcomputer like device, such as a general-purpose computer selectivelyactivated or reconfigured by a computer program stored in the computer.Alternately, the device may be implemented by an Application SpecificIntegrated Circuit (ASIC), etc.

Moreover, methods are described below. The methods and algorithmspresented herein are not necessarily inherently associated with anyparticular computer or other apparatus. Rather, various general-purposemachines may be used with programs in accordance with the teachingsherein, or it may prove more convenient to construct more specializedapparatus to perform the required method steps. The required structurefor a variety of these machines will become apparent from thisdescription.

In all cases there should be borne in mind the distinction betweenmethods in this description, and the method of operating a computingmachine. This description relates both to methods in general, and alsoto steps for operating a computer and for processing electrical or otherphysical signals to generate other desired physical signals.

Programs are additionally included in this description, as are methodsof operation of the programs. A program is generally defined as a groupof steps leading to a desired result, due to their nature and theirsequence. A program is usually advantageously implemented as a programfor a computing machine, such as a general-purpose computer, a specialpurpose computer, a microprocessor, etc.

Storage media are additionally included in this description. Such media,individually or in combination with others, have stored thereoninstructions of a program made according to the invention. A storagemedium according to the invention is a computer-readable medium, such asa memory, and is read by the computing machine mentioned above.

Performing the steps or instructions of a program requires physicalmanipulations of physical quantities. Usually, though not necessarily,these quantities may be transferred, combined, compared, and otherwisemanipulated or processed according to the instructions, and they mayalso be stored in a computer-readable medium. These quantities include,for example electrical, magnetic, and electromagnetic signals, and alsostates of matter that can be queried by such signals. It is convenientat times, principally for reasons of common usage, to refer to thesequantities as bits, data bits, samples, values, symbols, characters,images, terms, numbers, or the like. It should be borne in mind,however, that all of these and similar terms are associated with theappropriate physical quantities, and that these terms are merelyconvenient labels applied to these physical quantities, individually orin groups.

This detailed description is presented largely in terms of flowcharts,display images, algorithms, and symbolic representations of operationsof data bits within at least one computer readable medium, such as amemory. Indeed, such descriptions and representations are the type ofconvenient labels used by those skilled in programming and/or the dataprocessing arts to effectively convey the substance of their work toothers skilled in the art. A person skilled in the art of programmingmay use these descriptions to readily generate specific instructions forimplementing a program according to the present invention.

Often, for the sake of convenience only, it is preferred to implementand describe a program as various interconnected distinct softwaremodules or features, individually and collectively also known assoftware. This is not necessary, however, and there may be cases wheremodules are equivalently aggregated into a single program with unclearboundaries. In any event, the software modules or features of thisdescription may be implemented by themselves, or in combination withothers. Even though it is said that the program may be stored in acomputer-readable medium, it should be clear to a person skilled in theart that it need not be a single memory, or even a single machine.Various portions, modules or features of it may reside in separatememories, or even separate machines. The separate machines may beconnected directly, or through a network, such as a local access network(LAN), or a global network, such as the Internet.

It will be appreciated that some of these methods may include softwaresteps that may be performed by different modules of an overall softwarearchitecture. For example, data forwarding in a router may be performedin a data plane, which consults a local routing table. Collection ofperformance data may also be performed in a data plane. The performancedata may be processed in a control plane, which accordingly may updatethe local routing table, in addition to neighboring ones. A personskilled in the art will discern which step is best performed in whichplane.

An economy is achieved in the present document in that a single set offlowcharts is used to describe both programs, and also methods. So,while flowcharts are described in terms of boxes, they can mean bothmethod and programs.

For this description, the methods may be implemented by machineoperations. In other words, embodiments of programs are made such thatthey perform methods of the invention that are described in thisdocument. These may be optionally performed in conjunction with one ormore human operators performing some, but not all of them. As per theabove, the users need not be collocated with each other, but each onlywith a machine that houses a portion of the program. Alternately, someof these machines may operate automatically, without users and/orindependently from each other.

Methods are now described.

FIG. 5 is a flowchart of example methods for detecting setup optionchange in a medical device according to embodiments. The method offlowchart 500 may be practiced by any of the portions of the system 300illustrated in FIG. 3, which, in turn, may include the medical device102 of FIG. 1 or external defibrillator 200 of FIG. 2. Particularcomponents described below as performing various method processes aremerely examples of where such processes may be performed, as variouscomponents within the system described above are capable of performingthe described processes.

A flowchart 500 receives a settings signature of user settings of amedical device over a communication network at a process 504 when, forexample, the remote configuration and device monitoring system 320 (FIG.3) receives the settings signature 364 over the communication network306. An optional process 502 stores the original settings signature. Forexample, the stored settings signature 325 of FIG. 3 that was specifiedwhen setting up the device may be stored in the remote configuration anddevice monitoring system 320, or elsewhere. As described above, thesettings signature 364 may be sent periodically by the medical device302, or it may be sent based on a particular request. Then, theflowchart 500 outputs a warning in a process 514 if it is determinedfrom the settings signature 364 that the internal setting deviates froman expected state of the internal setting. This may be accomplished, forinstance, in the optional processes 506 and 510 by the remoteconfiguration and device monitoring system 320 comparing a storedsettings signature 325 to a latest settings signature 326, and thengenerating the warning if the signatures differ from one another.

In this description, numerous details have been set forth in order toprovide a thorough understanding. In other instances, well-knownfeatures have not been described in detail in order to not obscureunnecessarily the description.

A person skilled in the art will be able to practice the presentinvention in view of this description, which is to be taken as a whole.The specific embodiments as disclosed and illustrated herein are not tobe considered in a limiting sense. Indeed, it should be readily apparentto those skilled in the art that what is described herein may bemodified in numerous ways. Such ways can include equivalents to what isdescribed herein. In addition, the invention may be practiced incombination with other systems.

The following claims define certain combinations and subcombinations ofelements, features, steps, and/or functions, which are regarded as noveland non-obvious. Additional claims for other combinations andsubcombinations may be presented in this or a related document.

What is claimed is:
 1. A method for use with a medical device having acomponent for administering a treatment to a patient or for receivingdata of the patient, the component configured to operate according to aninternal setting, the medical device generating a settings signaturethat represents a present state of the internal setting, the methodperformed by a remote monitoring facility coupled to a communicationnetwork, the method comprising: receiving a version of the settingssignature generated by the medical device over the communicationnetwork; and outputting a warning if it is determined from the settingssignature that the internal setting deviates from an expected state ofthe internal setting.
 2. The method of claim 1, further comprising:storing the settings signature.
 3. The method of claim 2, furthercomprising: comparing the settings signature to a previously storedsignature of the internal setting, and in which the warning is outputbased on the comparison.
 4. The method of claim 1, in which the systemfurther comprises a remote configuration facility, the method furthercomprising: in the remote configuration facility, specifying aparticular setup configuration of the internal setting; and transmittingdata identifying the particular setup configuration to the medicaldevice across the communication network.
 5. The method of claim 1, inwhich the version of the settings signature is received from the medicaldevice periodically.
 6. The method of claim 1, in which the version ofthe settings signature is received from the medical device based on anevent at the medical device.
 7. The method of claim 6, furthercomprising: transmitting a query to the medical device, and in which theevent is the receipt of the query at the medical device.
 8. The methodof claim 1, further comprising: communicating the warning to an agencyother the medical device.
 9. A system for use with a medical devicehaving a component for administering a treatment to a patient or forreceiving data of the patient, the system comprising: a processor; and amemory storing instructions which, when executed by the processor resultin: sending a version of the settings signature generated by the medicaldevice over a communication network; and outputting a warning if it isdetermined from the settings signature that the internal settingdeviates from an expected state of the internal setting.
 10. The systemof claim 9, in which the settings signature is stored.
 11. The system ofclaim 10, in which the settings signature is compared to a previouslystored signature of the internal setting, and the warning is generatedbased on the comparison.
 12. The system of claim 9, in which the systemfurther comprises a remote configuration facility that includes a secondprocessor and a second memory, the system also further comprising: inthe remote configuration facility, instructions stored in the secondmemory which, when executed by the second processor result in:specifying a particular setup configuration of the internal setting; andtransmitting data identifying the particular setup configuration to themedical device across the communication network.
 13. The system of claim9, in which the version of the settings signature is sent from themedical device periodically.
 14. The system of claim 9, in which theversion of the settings signature is sent from the medical device basedon an event at the medical device.
 15. The system of claim 14, in whicha query is transmitted to the medical device, and the event is thereceipt of the query at the medical device.
 16. The system of claim 9,in which the warning is communicated to an agency other the medicaldevice.